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Acute lymphoblastic leukaemia is a common childhood malignancy of multifactorial pathogenesis and may present before 12 months of age2; such an early onset has inspired research into any prenatal gene abnormalities in diagnosed individuals. Clinical application of rDBS research is still in its infancy but has potential in population-wide disease tracking and epidemiological studies. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity. Christy WM Leung 1; NS Cheng; D2; TF Leung 2,3 1 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 2 Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China 3 Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China

Within food webs, trophically transmitted helminth parasites use predator-prey links for their own transfer from intermediate prey hosts, in which they occur as larval or juvenile stages, to predatory definitive hosts, in which they reach maturity. In large taxa that can be used as intermediate and/or definitive hosts, such as fish, a host species' position within a trophic network should determine whether its parasite fauna consists mostly of adult or larval helminths, since vulnerability to predation determines an animal's role in predator–prey links. Using a large database on the helminth parasites of 303 fish species, we tested whether the proportion of parasite species in a host that occur as larval or juvenile stages is best explained by their trophic level or by their body size. Independent of fish phylogeny or habitat, only fish body length emerged as a significant predictor of the proportion of parasites in a host that occur as larval stages from our multivariate analyses. On average, the proportion of larval helminth taxa in fish shorter than 20 cm was twice as high as that for fish over 100 cm in length. This is consistent with the prediction that small fishes, being more vulnerable to predation, make better hosts for larval parasites. However, trophic level and body length are strongly correlated among fish species, and they may have separate though confounded effects on the parasite fauna exploiting a given species. Helminths show varying levels of host specificity toward their intermediate host when the latter is the downstream host involved in trophic transmission toward an upstream definitive host. Given this broad physiological compatibility of many helminths with fish hosts, our results indicate that fish body length, as a proxy for vulnerability to predators, is a better predictor of their use by helminth larvae than their trophic level based on diet content.

Background The prevalence of daily cigarette smoking has dropped to 10% in Hong Kong (HK) in 2017, however, smoking still kills 5700 persons per year. Studies suggest that abstinence rates are higher with combined NRT than single NRT, although local data on safety and benefits of combined NRT are lacking. The aim of this study is to compare the effectiveness of combined NRT with single NRT among HK Chinese. Methods This is a one-year, two-arm, parallel randomised trial. Five hundred sixty smokers, who smoked ≥10 cigarettes/day for ≥1 year, were randomized to combined and single NRT. Combined NRT group received counseling and nicotine patch & gum. Single NRT group received counselling and nicotine patch. Primary outcome was abstinence rate measured as self-reported 7-day point prevalence with CO validated at 52 weeks. Secondary outcomes included smoking abstinence rates at 4, 12, & 26 weeks. Crude odds ratio and p -value were reported from logistic regression without adjustment; for trend analysis, adjusted odds ratio (AOR) and p-value were reported from Generalized Estimating Equation (GEE) (controlling for time). All AORs were adjusted for age, sex, baseline CO and clusters. Results Abstinence rates at 4, 12, 26 and 52 weeks were all higher in the combined NRT group (35.8, 21.9, 16.8, 20.1%) compared with the single NRT group (28, 16.8, 11.2, 14.3%). At 4 weeks, combined NRT group was more likely to quit smoking (OR 1.43, 95% CI, 1.00 to 2.05) than the single NRT group. From GEE analysis, combined NRT group had a significantly higher abstinence rate (23.6%) than the single NRT group (17.6%) across repeated measures at all-time points. Combined NRT group was more likely to quit smoking (OR 1.43, 95% CI, 1.15 to 1.77). No significant difference in the side effect profile was detected between groups. Conclusions Smokers given 8 weeks of combined NRT were more likely to quit smoking at 4, 12, 26 and 52 weeks compared with single NRT. Combined NRT was as well tolerated as single NRT and it should be further promoted in our community. Trial registration NCT03836560 from ClinicalTrial.gov , 9 Feb 2019.

Characteristics of allergen-specific immunotherapy Allergen-specific immunotherapy (AIT), which is yet to be popularised in Hong Kong, is a disease-modifying therapy.3 It modifies the host immune system to the state of immunological tolerance by reducing mast cell activity and IgE release in response to allergen exposure, while also increasing numbers of regulatory T-cells.3 House dust mite allergen[-]specific immunotherapy There are various AIT formulations, including those that target HDM allergens.4 The initiation of HDM AIT requires that allergic disease be diagnosed by a physician and that sensitisation be demonstrated by measurement of serum HDM-specific IgE levels or a positive skin prick test to extracts from D pteronyssinus and D farinae. Disease factors Severity Clinical confirmation of allergic disease and atopy-triggered disease burden are equally important for assessing severity, with the latter categorised using established grading systems, including the ARIA (Allergic Rhinitis and its Impact on Asthma) guideline,9 the Asthma Control Test,10 and the Scoring Atopic Dermatitis (SCORAD) index.11Both the ARIA guideline and the Asthma Control Test assess the effects of allergic disease and atopic symptoms on quality of life and activities of daily living; at the same time, they inquire about sleep disturbances and use of rescue medication, respectively.9 10 On the other hand, the SCORAD index includes both subjective assessment of pruritus and sleep disturbance as well as objective signs of typical cutaneous manifestations.11 Contra-indications Concomitant use of beta-blockers and poorly controlled asthma are well-established and absolute contra-indications to AIT,12 since these patients are at risk of more severe AEs and treatment-resistant anaphylaxis.7 12 In fact, the majority of AIT-associated deaths have occurred in severe asthmatics.13 Relative contra-indications include coexisting active autoimmune disease and active malignancies,14since there is an argument for the use of a risk-benefit analysis in such patients. While it is a self-financed item and mainly administered as a private healthcare service in Hong Kong,15 the cost is covered by health insurance in some countries.16 The availability of insurance coverage and ease of making claims are significant factors in patients continuing treatment.16 Cost-effectiveness Although the costs of AIT are not available for public reference, several studies have assessed its incremental cost-effectiveness ratio.7 Healthcare authorities in countries across the world set their own cost-effectiveness thresholds, albeit with varying values, and treatments with sub-threshold incremental cost-effectiveness ratios are considered to be cost-effective. [...]contrary to the popular belief that AIT takes years to work, clinical improvements can be observed at as early as 8 weeks for ocular symptoms (any watery, red, gritty or itchy eyes) and 14 weeks for nasal and asthmatic symptoms.8 18 The onset of action varies according to treatment dose and the type and severity of allergic disease.8 Allergen-specific immunotherapy, which is currently the only curative therapy for allergy, is associated with long-term symptom remission.19 In a study by Cools et al,19 patients with asthma either received the standard level of care or HDM AIT.

The Chinese government announced in 2006 its commitment to build 'a strong social work force' to deal with the upsurge of social problems and realise the political vision of maintaining a 'harmonious socialist society'. Assigned to perform the welfare role historically played by government cadres, volunteers or kinship networks, social workers in China have encountered many difficulties in defining and claiming their practice mandate at work sites. Based on a qualitative study conducted in Shenzhen and Guangzhou, this paper discusses the struggles social workers had, as they attempted to establish their exclusive purview of work and professional role, and uncovers the street-level micro politics in the welfare work sites, as different actors competed to define the social work mandate in their respective interests.

To the Editor—Unlike adults, children appear to be fortunately spared from the direct effects of coronavirus disease 2019 (COVID-19).1 However, the closure of schools and restrictions on public gatherings, coupled with prolonged social distancing and isolation measures may result in adverse physical and psychosocial consequences for children and adolescents. Children with special physical or psychosocial needs, pre-existing mental health problems, or migrant backgrounds are particularly vulnerable to this adversity.7 The United Nations provides guidance to nations and non-government organisations on safeguarding and mitigating the impacts of COVID-19 on children globally, including the most vulnerable children living in low-income countries,8with progress advised on three fronts: information, solidarity, and action.9 In order to mitigate this public health threat, regular and emergency child and adolescent psychiatric services must be maintained. [...]research must be carried out to understand the psychosocial effects of social distancing and home schooling, identify risk and resilience factors, prevent long-term mental health consequences especially child maltreatment, and explore the feasibility and optimal model of telepsychiatry. Karen KY Leung 1; Samantha PW Chu2; KL Hon 1,3; TF Leung 3 1 Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong 2 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 3 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong

\"Client participation\" is a popular ideal and object of rhetorical commitment in social work service. But the much-touted potential of this concept requires careful and critical scrutiny. This article reports on a study of client-participation initiatives in the Hong Kong welfare sector. The study identified significant differences in the institutional structure of client-participation initiatives and their social dynamics between service units targeting elderly people or people with disabilities and those targeting a clientele with supposed moral or psychosocial failures. The findings suggest that client-participation mandates allowing sustained interaction with service users through regular membership in a structure for discussion are more effective than ad hoc measures with unstable participation, assuming that the goal is mutuality and trust in cooperative inquiry with service users. The findings also suggest that both a service provider's genuine belief in the primacy of the users' voice and a user's legitimate claim of experiential knowledge are imperative to realizing the potential of client participation.

Skin hydration (SH) and transepidermal water loss (TEWL) are important skin biophysical parameters for assessment of childhood eczema. This study investigated whether age, sex, and disease status influence these parameters. Skin hydration and TEWL were measured by Delfin MoistureMeterSC and Delfin Vapometer SWL5, respectively, among children aged ≤18 years with and without eczema. Disease status was evaluated using Scoring Atopic Dermatitis (SCORAD) and Nottingham Eczema Severity Score (NESS) clinical tools. Clinical scores and objective measurements were reviewed for 132 patients with eczema and 120 patients without eczema. In both sexes, SH was significantly higher among children aged ≤2 years with and without eczema than among children aged >2 years with and without eczema. Among children aged >2 years, SH was higher among girls with and without eczema than among boys with and without eczema. Regardless of age or sex, SH was lower among children with eczema than among children without eczema. Age-, sex-, and disease-related differences were not observed for TEWL. Skin hydration was negatively correlated with objective SCORAD ( =-0.418, P<0.001), overall SCORAD ( =-0.385, P<0.001), oedema/papulation ( =-0.243, P=0.041), lichenification ( =-0.363, P=0.002), dryness ( =-0.415, P<0.001), and intensity ( =-0.266, P=0.025). Transepidermal water loss was positively correlated with objective SCORAD ( =0.209, P=0.018), overall SCORAD ( =0.215, P=0.015), and lichenification ( =0.240, P=0.043). Skin hydration was negatively correlated with TEWL among children without eczema ( =-0.401, P<0.001), but not among children with eczema. Skin hydration can be used to distinguish clinical differences in eczema based on age, sex, and disease status.

2015 marked the 25th anniversary of the commercial use and availability of genetically modified crops. The area of planted biotech crops cultivated globally occupies a cumulative two billion hectares, equivalent to twice the land size of China or the United States. Foods derived from genetically modified plants are widely consumed in many countries and genetically modified soybean protein is extensively used in processed foods throughout the industrialised countries. Genetically modified food technology offers a possible solution to meet current and future challenges in food and medicine. Yet there is a strong undercurrent of anxiety that genetically modified foods are unsafe for human consumption, sometimes fuelled by criticisms based on little or no firm evidence. This has resulted in some countries turning away food destined for famine relief because of the perceived health risks of genetically modified foods. The major concerns include their possible allergenicity and toxicity despite the vigorous testing of genetically modified foods prior to marketing approval. It is imperative that scientists engage the public in a constructive evidence-based dialogue to address these concerns. At the same time, improved validated ways to test the safety of new foods should be developed. A post-launch strategy should be established routinely to allay concerns. Mandatory labelling of genetically modified ingredients should be adopted for the sake of transparency. Such ingredient listing and information facilitate tracing and recall if required.

Background: Recent studies have repeatedly shown weak correlations among lung function parameters, atopy, exhaled nitric oxide level (Feno), and airway inflammatory markers, suggesting that they are non-overlapping characteristics of asthma in adults. A study was undertaken to determine, using factor analysis, whether the above features represent separate dimensions of childhood asthma. Methods: Clinically stable asthmatic patients aged 7–18 years underwent spirometric testing, methacholine bronchial challenge, blood sampling for atopy markers and chemokine levels (macrophage derived chemokine (MDC), thymus and activation regulated chemokine (TARC), and eotaxin), Feno, and chemokines (MDC and eotaxin) and leukotriene B4 measurements in exhaled breath condensate (EBC). Results: The mean (SD) forced expiratory volume in 1 second (FEV1) and Feno of 92 patients were 92.1 (15.9)% predicted and 87.3 (65.7) ppb, respectively. 59% of patients received inhaled corticosteroids. Factor analysis selected four different factors, explaining 55.5% of total variance. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.587. Plasma total and specific IgE levels, peripheral blood eosinophil percentage, and Feno loaded on factor 1; plasma TARC and MDC concentrations on factor 2; MDC, eotaxin and leukotriene B4 concentrations in EBC on factor 3; and plasma eotaxin concentration together with clinical indices including body mass index and disease severity score loaded on factor 4. Post hoc factor analyses revealed similar results when outliers were excluded. Conclusions: The results suggest that atopy related indices and airway inflammation are separate dimensions in the assessment of childhood asthma, and inflammatory markers in peripheral blood and EBC are non-overlapping factors of asthma.